NPI | 1063478675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 28129) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 28129) |
Enumeration Date | 2006-04-22 |
Last Update Date | 2023-06-13 |